Noor Asif, Krilov Leonard R, D'Agati Vivette, Chandra Manju
Department of Pediatrics, NYU Winthrop Hospital, Mineola, New York, USA.
Department of Pathology, Columbia University Medical Center, New York City, New York, USA.
BMJ Case Rep. 2018 Jul 18;2018:bcr-2018-225371. doi: 10.1136/bcr-2018-225371.
Infection-related glomerulonephritis results from glomerular immune complex deposition due to a variety of potential pathogens. Poststreptococcal glomerulonephritis is the best known example. We present a case of acute infection-related glomerulonephritis associated with disseminated gonococcal infection in a sexually active 13-year-old girl, the first report of such an association in the absence of endocarditis. The patient presented with features of acute disseminated gonococcal infection including fever, hypotension, tenosynovitis, polyarthralgias and petechiae. She developed hypocomplementemic glomerulonephritis synchronous with the acute infection. The renal biopsy revealed a diffuse endocapillary proliferative and exudative glomerulonephritis with subepithelial electron-dense humps and granular glomerular capillary wall staining for C3 and IgG, typical of acute postinfectious glomerulonephritis. After treatment and resolution of the gonococcal infection, the serum creatinine, complement levels and urine sediment normalised. The only residual renal damage 16 months later was low-grade proteinuria.
感染相关性肾小球肾炎是由多种潜在病原体导致肾小球免疫复合物沉积引起的。链球菌感染后肾小球肾炎是最广为人知的例子。我们报告了一例13岁性活跃女孩发生的与播散性淋球菌感染相关的急性感染相关性肾小球肾炎病例，这是在无心内膜炎情况下此类关联的首例报告。患者表现出急性播散性淋球菌感染的特征，包括发热、低血压、腱鞘炎、多关节痛和瘀点。她在急性感染的同时出现了低补体血症性肾小球肾炎。肾活检显示弥漫性毛细血管内增生性和渗出性肾小球肾炎，伴有上皮下电子致密驼峰以及肾小球毛细血管壁C3和IgG颗粒状染色，这是急性感染后肾小球肾炎的典型表现。在淋球菌感染得到治疗并消退后，血清肌酐、补体水平和尿沉渣恢复正常。16个月后唯一残留的肾脏损害是轻度蛋白尿。
